妊娠合并癫痫16例临床分析

Clinical Analysis of Epilepsy during Pregnancy

目的探讨妊娠合并癫痫临床处理。方法回顾性分析16例妊娠合并癫痫孕妇服抗癫痫药情况、癫痫发作频率变化及妊娠结局。结果妊娠合并癫痫发生率0.078%,原发性4例,继发性12例。全身性癫痫发作13例(2例癫痫持续状态),局部癫痫发作3例。孕期发作频率增加者5例,无变化者6例。孕期新发现单次发作5例。孕期未用抗癫痫药物(AEDs)3例,间断用药1例,连续用药7例,均为单一AEDs治疗。顺产4例,剖宫产10例,人工流产2例。新生儿出生无窒息,平均出生体重2852g,无新生儿出生缺陷,无新生儿死亡。母亲亦无产科并发症发生。2例人工流产孕妇癫痫持续状态、吸入性肺炎死亡,1例智力低下孕妇产后卡马西平中毒昏迷,抢救成功。结论妊娠可诱发并使癫痫发作频率增加。孕期用AEDs可控制癫痫发作。应采用单一AEDs治疗,且应按时监测血浆中AED及叶酸水平。

Objective To evaluate the management and treatment of epilepsy during pregnancy. Methods We reviewed medical records of sixteen cases with epilepsy during pregnancy at our hospital from May/1990 to May/2005. Results The incidence of pregnant with epilepsy was 0.078% , 4 cases with primary epilepsy and 12 cases with secondary epilepsy. 13 cases were generalized epilepsy （two of them were status epilepticus ）, while 3 cases were partial epilepsy. 5 cases had an increase in seizure frequency, while 6 cases showed no change. 5 cases had generalized epilepsy only once during pregnancy. 3 cases did not take antiepileptic drugs （AEDs） during pregnancy; 7 cases took AEDs continuously ; only 1 case took AEDs intermittently. All cases used a single anticonvulsant. 4 cases had natural delivery; 10 cases had cesarean delivery; 2 cases had artificial abortion. The newborns showed no asphyxia or birth defect. The average body weight was 2 825 g. 2 cases with status epilepticus were died of meconium aspiration. 1 case with mental retardation fell in coma because of carbamazepine intoxication during postpartum, and was rescued successfully. Conclusion Pregnancy can provoke and advance seizure frequency of epilepsy. Taking AEDs during pregnancy can control epilepsy seizure. Patients should be treated with one drug only and monitored the levels of folic acid and AED.